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# Form 13February 1946# UNITED STATES CIVIL SERVICE COMMISSIONPROOF OF RESIDENCEApplications for appointment in the departmental service must be accompanied by a certificate showing legal or voting residence in the State or Territory claimed. Evidence must be of at least one year next preceding the date of making application. Therefore, if you are employing legal or voting residence in the appointment service, the following questions must be answered, and the Jurat and Officer’s Certificate of Residence below must be executed. Failure to submit this form, properly executed, with your application may result in loss of consideration for appointment applicants who hold permanent positions in the departmental service are not required to have the Officer’s Certificate of Residence executed. Am in the departmental service.1. Name of examineeMr.Mrs. Zehrung Charlotte L.2. Street and number, or rural, R. D., number2601 16th St. N.W. #7253. Home of examinee:   Statistical Draftsman4. Post office (including postal zone) and State   Washington, D.C5. Place and date of written examination (if any)6. (a) In what State or Territory do you have:   Legal residence: Ohio   Voting residence:   From Jan 1929 to Feb. 1950 Voting residence7. If during the past year you have not resided continuously in the State or Territory in which you claim legal or voting residence, or are not now actually living in such State or Territory, indicate in the following blanks the dates of absences, and locations and occupations during such absences:(a) Date left (Month, Year) (b) Date returned (Month, Year) (c) Location during absence (City and State) (d) OccupationSept. '49 Dec. '49 Syracuse, N.Y StudentJan. '50 Washington, D.C Typist8. If you are under 21 years of age, fill in the following blanks:(a) Legal residence of parent or guardian(b) Length of such residence:(c) Present post office address of parent or guardianState:Is he a voter in that State? Yes NoCounty:From ... 19.. to ... 19.. City or town:From ... 19.. to ... 19.. County:State:9. If you are a married woman, fill in the following blanks:(a) Date of marriage(b) Legal residence of husband(c) Length of such residenceState:Is he a voter in that State? Yes NoCounty:From ... 19.. to ... 19..From ... 19.. to ... 19..## JURAT (OR OATH)This Jurat (or oath) must be executed before a notary public, county, municipal, or price court clerk or other officer authorized to administer oaths, and the certificate must bear his official seal, or, in lieu thereof, certification of his official character by the proper officer under official seal.I, the undersigned, DO SOLEMNLY SWEAR (OR AFFIRM) that the statements made by me in answer to the foregoing questions are full and true to the best of my knowledge and belief.Signature of applicant:Charlotta L. ZehrungSubscribed and sworn to (or affirmed) before me this 4th day of Feb 1950.![signature of Notary Public]Notary PublicMy commission expires March 31, 1954## OFFICER'S CERTIFICATE OF RESIDENCEInstructions - If the applicant’s claim is based on legal residence, the certificate must be executed by a notary public, county, municipal, or price court clerk, mayor, justice of the peace, or other officer in the county or city in which the applicant claims residence. If based on voting residence alone, the certificate must be executed by the registrar of voters or other officer of the Board of Elections. In other cases the officer must be an actual resident and officer in the city or county claimed by the applicant, and the certificate must bear his official seal, or, in lieu thereof, certification of his official character by the proper officer under official seal.The applicant is not required to appear in person before the officer who executes this certificate, but the officer should satisfy himself from credible and competent evidence as to facts to which he certifies.I, a Notary of the county of Montgomery and State (or Territory) of Ohio, do hereby certify that Charlotte L. Zehrung the applicant who takes the above in connection with a civil service examination, is now a Legal resident of Montgomery county, and State (or Territory) of Ohio exactly within it as given that above and has been such resident for 21 years 1 months next preceding the date hereof.![OFFICIAL SEAL]Ky commission expires July-19-1952Attest.West Carrollton, County of Montgomery, and State (or Territory) of Ohio, this 14th day of February 1950.Clarence H. Bloss, Jr.The Official seal must not be omitted. If erasure or correction is made in the “Officer’s Certificate,” certification must be made on margin by the officer who executes the certificate, showing such correction.